Incidence and etiology of omphalitis in Pakistan: A community-based cohort study

Fatima Mir, Shiyam Sundar Tikmani, Sadia Shakoor, Haider Javed Warraich, Shazia Sultana, Syed Asad Ali, Anita K.M. Zaidi

Research output: Contribution to journalReview articlepeer-review

33 Citations (Scopus)


Introduction: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Methodology: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Results: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10%); Pseudomonas spp., 52 (8.9%); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). Conclusions: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.

Original languageEnglish
Pages (from-to)828-833
Number of pages6
JournalJournal of Infection in Developing Countries
Issue number12
Publication statusPublished - Dec 2011


  • Antimicrobial susceptibility
  • Community acquired
  • Etiology
  • Incidence
  • MRSA
  • Newborn
  • Omphalitis
  • Staphylococcus aureus
  • Umbilical infection


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